Pharm Unit 6 Book Quiz

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UNIT 6 BOOK QUIZQuestion 1 .The APN understands that loperamide works by whichmechanism?•1.Supplying missing bacteria to the gastrointestinal (GI) tract.correci2. Decreasing gastric and bowel motility•3.Coating the wTalls of the gastrointestinal (GI) tract and binding totoxins.4.Stimulating peristalsis and gastric motilityRationales•Optionl:This describes the mechanism of a probiotic.■Option2:Loperamide binds to the opiate receptors of the intestine,leading to a decrease in gastric and intestinal motility.•Option3:This describes the mechanism of an adsorbent..Option4:This describes the mechanism of a stimulant laxative orprokinetic agent.[Page Reference: 485]Question 2 .A patient underwent sternotomy and coronary artery bypasssurgery yesterday. It is important to avoid straining for a bowTel movementpostoperatively. Which laxative would be the best choice for this type ofpatient?•1.Psyllium.2.Lubiprostone•3.Methylnaltrexone•correct4. DocusateRationales•Option1:Bulk-forming laxatives are used for simple, chronicconstipation.•Option2:Lubiprostone is used for women who have irritable bowTelsyndrome (IBS) with constipation.

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Option 3:Methylnaltrexone is used for treating constipation fromchronic opioid use.•Option 4:Surfactants. or "stool softeners." are commonly prescribedpostoperatively to prevent straining and the resultant pressure on thesurgical incision.[Page Reference: 5161Q u e s t i o n s .Many patients, particularly older adults, take over-the-counter(OTC) laxatives regularly. Which statement about laxative use is accurate?.1.Patients cannot become dependent on laxatives.•corrects. Fluid and electrolyte imbalances can occur.•3.Persons with Crohn's disease often abuse laxatives and take toomany.•4.Castoroilis good choice of laxativefora pregnant woman.Rationales•Optionl:This is untrue. Many patients become dependent onlaxatives for a bowel movement, particularly with the overuse ofstimulant laxatives.•Option2:This is especially true of older adults using bulk-forminglaxatives or hyperosmolar agents.■Option 3:Laxative abuse is commonly seen in those with personalitydisorders and women with depression or anorexia nervosa.•Option4:Castor oil induces uterine contractions and should not beused.[Page Reference: 5 1 6 ]Question 4.A patient with a body mass index (BMI) of 28 has recentlybeen diagnosed with gastroesophageal reflux disease (GERD), andomeprazole has been prescribed. Which advice would the APN give thispatient regarding lifestyle changes?•l."You should eat meals high in carbohydrates."•2."Small amounts of alcohol are OK."

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corrects. "Attaining a healthy weight will help reduce symptoms ofGERD."4."Drinking peppermint tea before bed will help."Rationales«Optionl:High-carbohydrate meals will worsen GERD.•Option2:Alcohol decreases lower esophageal sphincter tone and wTillmake GERD worse.•Option 3:Obesity increases abdominal pressure and will worsenGERD.•Option4:Peppennint decreases lower esophageal sphincter tone andwill make GERD w’orse.[Page Reference: 10581Question 5 .Prior to initiating therapy with misoprostol for a 30-year-oldwoman, which question is essential for the APN to ask?•correctl. "Is there any possibility that you might be pregnant?"«2."Do you take any other pain medication?"•3."Are you taking any antacids or [histamine-2] Hz blockers rightnow?".4."How long have you been suffering from arthritis?"Rationales■Option1:Misoprostol is an abortifacient and is Pregnancy CategoryX. Determining whether the patient is pregnant is the top prioritybefore prescribing this medication.•Option 2:Misoprostol is a cytoprotective agent. Although it isimportant to evaluate other medications the patient might take, it isnot the priority in this instance.•Option 3:Although this is important to evaluate, it is not the priority.■Option4:The diagnosis is not relevant to the safe administration ofmisoprostol in this instance.[Page Reference: 498]

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Question 6.A 25-year-old female patient is about to embark on a 2-weekcruise for her honeymoon, and she is worried because she experiencesseasickness. She asks about using a scopolamine patch. Which advice wouldthe APN provide the patient about this medication?•correct!. "Apply the patch behind your ear 4 hours before getting onthe ship."•2."Change the patch every morning while on the ship."•3."When you change the patch, put it behind the same ear.".4."Only apply the patch to your arm if you experience seasickness."Rationales•Option 1:The patch should be applied behind the ear 4 hours beforetraveling..Option2:The patch can be leftinplace for up to 3 days.1Option 3:If therapy is still needed after 3 days, the new patch shouldbe placed behind the other ear.•Option4:The patch should be applied behind the ear 4 hours beforetraveling.[Page Reference: 497]Question 7 .A patient consults the APN because of concerns aboutexperiencing repeated bouts of vertigo and nausea. The patient askswhether anything can be prescribed to help. Which medication would bemost appropriate for this patient?.1.Prochlorperazine 10 mg oral tablet•2.Aprepitant 40 mg capsule■corrects. Meclizine 25 mg oral tablet.4.Dolasetron 100 mg tabletRationales■Option1:Prochlorperazine is not usually effective for treatingvertigo.Option2:Aprepitant is used for nausea and vomiting in patientsreceiving chemotherapy.

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Option 3:Antihistamines act on the vestibular system andchemoreceptor trigger zone (CTZ) and thus are good for vertigo andits associated nausea.•Option4:Doiasetron is used for preventing nausea and vomiting aftersurgery or chemotherapy.[Page Reference: 494]Question S.A patient is to start taking esomeprazole for the treatment ofgastroesophageal reflux disease (GERD). Which instruction must the APNgive the patient regarding this medication?•l.Take this medication with every meal.•correct2.Take the medication at least 1 hour before a meal.•3.Take the medication 1 to 3 hours after meals..4.Take the medication every time you experience heartbum.Rationales•Option1:Esomeprazole is most effective when given 1 hour prior to ameat and it is not taken with every meal.•Option 2:Esomeprazole is most effective when given 1 hour prior to ameal..Option 3:Antacids should be taken 1 to 3 hours after meals and atbedtime.•Option 4:Esomeprazole should be taken daily for several weeks totreat GERD. If the patient has no relief of symptoms, he or she needsfurther investigation.[Page Reference: 10591Question 9 .Which medication works by bindingto thebase of ulcers andgastric erosions, thus forming a protective barrier?•1.Metoclopramide•corrects. Sucralfate•3.Aluminum carbonate•4.Bismuth subsalicylate

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Rationales•Option 1 :Metoclopramide is a prokinetic agent. It does not havethedescribed mechanism of action.•Option2:Sucralfate is a cytoprotective agent and binds to the base ofulcers and erosions.•Option 3:Aluminumcarbonate is an antacid. It does not have thedescribed mechanism of action.•Option4:Bismuth subsalicylate has numerous uses, including thetreatment of diarrhea. It does not have the described mechanism ofaction.[ P a g e Reference: 4 9 1 ]Question 1 0 . Apatient comes to the clinic complaining of a 2-day history7ofdiarrhea. He receives two tablets of diphenoxylate HC1with atropine sulfateto take orally as needed for each loose stool. The APN should inform himthat he may experience which symptom(s)?«l . Aslower heart rate than normal■2 .The need to urinate frequently•3 .An increase in appetite.correct!. Drowsiness and dizzinessRationales•Optionl:This medication occasionally causes tachycardia.•Option 2The anticholinergic effects of the medication may causeurinary retention.■Option3:Enhanced appetite is not caused by this medication.•Option 4:Diphenoxylate with atropine may cause sedation andpossibly dizziness.[ P a g e Reference: 485]Question 1 1 .When initiating long-term drug therapy with proton pumpinhibitors (PPls) for patients with severe gastroesophageal reflux disease(GERD), which of these is one of the four goals of treatment?•correct!. To reduce symptoms of reflux

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•2 .To remove barriers to adherence.3 .To prevent the development of vitamin B - deficiency•4.To cure the disorderRationales•Option 1:Reducing the symptoms of reflux is one of the four goals oftreatment•Option2:Any disease process where lifestyle modifications arecentral to management is prone to problems with adherence.•Option3:Vitamin B:2deficiency is a potential adverse effect of long-term treatment with PPIs and is not a goal of treatment.•Option4:GERD is a chronic condition. Patients with GERD mustunderstand the lifelong nature of the disorder and the need toincorporate the treatment regimen into their everyday lives.[Page Reference: 1 0 5 9 ]Question 1 2 .For which patient is docusate contraindicated?«l . Afemale patient with an 8-w’eek-old baby who is breastfeeding•2 .A female patient w’ho is 16 wTeeks pregnant«3.A male patient who has just undergone a thoracotomy•correct4.A male patient complaining of nausea and abdominal painRationales•Option1:Surfactants are safe for pregnant and breastfeedingwomen.■Option 2 :Surfactants are safe for pregnant and breastfeedingwomen.«Option3:Surfactants are often prescribed postoperaLively to preventstraining.•Option 4 :Laxatives should not be taken in the presence of nausea,vomiting, o r abdominal pain. The patient needs further investigationto rule out a bowTel obstruction.[Page Reference: 5 1 7 ]

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Question 1 3 .The APN is writing orders for a patient who is scheduled tohave a colonoscopy 3 days from now. Which medication should beprescribed to cleanse the entire gastrointestinal (GI) tract prior to thisprocedure?■correctl . Polyethylene glyco1■2 .Methylcellulose•3 .Lactulose.4. Docusate calciumRationales•Option 1:Polyethylene glycol is commonly used as bowel prep beforea colonoscopy.»Option 2:Methylcellulose isabulk-forming laxative used to treatsimple, chronic constipation.•Option 3 :Lactulose is most commonly used to treat hepaticencephalopathy.■Option4:Docusate is a surfactant, or "stool softener/1and wTould notcleanse the colon sufficiently.[ P a g e Reference: 5 0 2 ]Question 1 4 . A22-year-old female patient suffering from irritable bowelsyndrome (IBS) with constipation is seen at the clinic. Which medicationwould be most appropriate for this patient?•1 .Lactulose•2 .Mineral oil•corrects. Lubiprostone.4. PolycarbophilRationales•Optionl:Lactulose is a hyperosmolar laxative frequently prescribedto lower ammonia levels in patients with hepatic failure..Option 2 :Mineral oil is normally used to lubricate the intestines andis commonly used for fecal impaction. I t may decrease the absorptionof fat-soluble vitamins.

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Option3:Lubiprostone is a chloride channel activator and is used totreat IBS with constipation in women 18 years and older.•Option4:Polycarbophil isabulk-forming laxative used to treatsimple, chronic constipation.[Page Reference: 5 0 3 ]Question 1 5 .Considering eradication rates, adverse effects, antimicrobialresistance, and patient compliance, which regimen is most appropriate fortreatment ofH. pylon-induced peptic ulcer disease (PUD)?■correctl. Clarithromycin, amoxicillin, and a proton pump inhibitor(PPI)•2 .Tetracycline, metronidazole, and a proton pump inhibitor (PPI)•3.Clarithromycin, tetracycline, and a histamine-2 (Hi) blocker.4.Metronidazole, amoxicillin, and a histamine-2 (H2) blockerRationales«Optionl:This regimen has fewer adverse effects, less antibioticresistance, and good-to-excellent eradication rates.•Option 2 :Metronidazole has numerous adverse effects.•Option3:Proton pump inhibitors (PPIs) are the standard fortreatingH. pylori-induced PUD.•Option4:Proton pump inhibitors (PPIs) are the standard fortreatingH.py/ori-inducedPUD.Metronidazole has numerous adverseeffects .[ P a g e Reference: 1 0 6 2 ]Question 1 6 . A56-year-old male patient with diabetes has been taking aproton pump inhibitor (PPI) daily as prescribed for gastroesophageal refluxdisease (GERD) but still experiences significant acid reflux. Whichmedication could be prescribed to increase gastric emptying and helpimprove his symptoms?•correctl. Metoclopramide■2 .Famotidine•3.Prochlorperazine

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